Experiencing Kangaroo Mother Care
Posted by Elyse Marr
In my last post, I gave you some background on human factors research and my vision as an experience designer. With that in mind, today I want to bring you into an empathy session, a large part of our design process.
I am going to share a short story that I experienced in field about Manoj, a mother with 7 day-old hypothermic twins. I was visiting an NGO that focused solely on Kangaroo Mother Care as a community effort for infant care, where family members would provide skin-to-skin contact for warmth in their home. I was trying to take elements of these practices to develop our at home unit. Yet this NGO is a rare success where KMC has been effective solution for community behavior change.
If you have insights from your experiences that tie-in to the story, please share. KMC is one of our largest design challenges. I would love to bring your thoughts to our design table as well.
From Brilliant Bangalore,
Elyse
I followed the smeared red trail of paint on the cool compacted cow-dung ground. It led to a series of concentric circle into the center of the home where the sunlight was pouring in. Entering, I felt like I was crossing a series of chambers, and levels of intimacy. I arrived at a chula beside a door where embers were burning. There was a mixture of sculpted triangular logs made from cow dung pellets, a few pieces of brightly printed consumer product cardboard, and gnarled forest firewood. This was a small pristine chula, and particularly pleasing in form. This chula was obviously not for cooking, but for ceremonial purposes. It was a provider of heat: a protector from evil spirits that might linger with visitors.
I was asked to first warm my hands, then my feet. So, I took off my shoes and socks and one by one I put each extremity near the flame of the chula. Only then was I allowed to greet the mother and newborns. I met them half-way along this red trail – I greeted them at their door threshold, and they emerged from the dark quarters, not quite leaving the room. As I looked past the sheath of smoke filtering before me, Manoj Kumari and Kanchen Shukla were seated side by side, each holding a infant: Sowyma and Aniket.
As a new mother, Manoj was committed to a “saur”, or confines for a time of purification and childcare right after delivery. Only Kanchen, her sister-in-law, could tend to Manoj and the twins for first seven days after birth.
I had come to Manoj’s house with Saksham community mobilizers who taught Kangaroo Mother Care (KMC) to new mothers. KMC is skin-to skin contact that anyone can provide to a child. To put it simply, an adult’s chest keeps a constant body temperature and acts like a warmer for the newborn.
Manish, the man who accompanied me from Saksham’s timidly listened to my questions about the children off to the side. Suddenly he emerged from the courtyard, seating himself directly facing the door of the sour square on with a strong presence. I stopped my interview to see what I had said wrong. The questions I asked about the children had led Manish to believe these 1.7 kg were hypothermic and not being treated with KMC. We stopped the interview – and Manish immediately moved to action.
Cold to the touch. Blue in the lips. Yes, Yes, both of the twins are blue in some areas. The women’s engagement was no longer masked by shyness, even with many men around. They were listening. The urgency was evident. What can we do? I can teach you kangaroo mother care.
Swiftly moving, succinctly speaking. Manish confirmed that the children had caught “cold fever,” then he provided instructions for KMC. He moved his arms slowly to his sides, closing his hand together, and gave a nod for them to reenter the sour. His job was finished.
Try. Try now. The men left the inner quarters of the house, and I was the only woman left to help and observe the first KMC trial with Manoj and Kanchen. I waited outside the sour, unsure if I could go into the room and terrified of all the unknown practices that were around me. Manoj went first; I could see her backlit silhouette seated on the bed against the yellow haze of smoke and kerosene luminance.
Come. Come in. I was allowed to enter, since I had warmed my feet and hands, and the strict days of confinement in the “saur” were over. Yesterday, the twins had been held in the circle of red paint on the seventh day of life to receive their first blessing from the sun and family waters. As I hesitantly walked in, I looked for reassurance on Kanchen’s face that was illuminated by the yellow cast light. Even without language, I could understand her eyes asking me to help.
From under her pallav, I heard her unbuttoning her blouse. Together, we undressed Aniket. I gently pulled off his cap as she caught his head, which was smaller than a tennis ball. The delicate skin on his head was loose and translucent. Then she untied the small gauze cloth from around his waist, which was no larger than my wrist. She placed the child under her pallav, across her open blouse, and I took her black shawl and covered her and the child. She pulled at arm, telling me to sit by her.
I looked across the room to the sole light source: the kerosene lamp was the sitting on a wooden stool at the head of the mother across the room. As I timidly went over to ask if she needed anything more, I looked at Manoj again noting that she had properly set up KMC by herself. I nodded to her, good; you’ve done everything right. Manoj seemed at ease; she showed a delicate smile and a let go a breath of release. By that time, she had the child lying on her chest, sleeping. Manoj was a provider of meter, radiation, and protection. I sensed no distress as I looked at Sowyma (the second of the twins). She had hair all over her body and face that her body developed to try and keep warm. Her black hairs on her head were matted down on her skin with mustard oil and I could vividly see the tracing of her cranial suture lines that were still developing around her delicate head.
With the women enveloped in the darkness of the Shivgarh night, I tried to quietly exit the room. Kanchen caught my arm, asking me not to leave, to stay with her. Immobile for the children, Manoj and Kanchen were captive under the reminder of the vulnerability of their fragile children. I must go, I told her. I will see you again tomorrow, not knowing if she understood me. Holding my arm, I looked at Kanchen’s glowing golden-lit face again smiling her beautiful warming grin, yet her forehead wrinkled with a slight fear. In my gaze, I tried to tell her to keep her spirit, and to focus that energy on being mindful of these children. In return, I will keep my hope and spirits up with her in my mind, focusing energy to my responsibility to her. In those moments of life, I find myself saying a form of prayer in daily thought. Only when I nodded slowly up and down and looked in her eyes, did she release my arm.
As my foot touched the cool dung floor once more, I caught eye of older women peering down at me from the top of the brick wall in the adjoining house. I moved towards the door seeing that men were slowly re-entering the house for the night, I averted my eyes back down to the ground, said my thank you, and exited the house.